Agencies considering their options for an electronic patient care reporting (ePCR) system tend to ask similar questions. Some of these include: What is the service model? Is it hosted locally at the agency or by the vendor? What does the flow of the report look like? What data can be entered? How long does it take to complete a report? Does the system feature touch-screen, handwriting recognition or keyboard data entry methods, or a combination of these? How accessible is the data for purposes of report writing and reading across the agency? What interfaces exist for CAD data, monitor data, communication with receiving facilities, state reporting and fire reporting? How easy is it for field providers and administrators? What is the pricing model?
As a billing services and billing technology provider, I’m very familiar with these questions. Beyond having more than 100 installations of our ePCR solutions, we’re the largest EMS billing and technology company in the U.S. and routinely partner with many of the leading ePCR companies for our billing customers. It’s from this perspective that I address some of the meaningful benefits that an ePCR system can bring to the billing results of your agency.
Let’s focus on four issues—data security, reporting, cost and the potential of revenue upside. Although other topics may be worthy of consideration, these four are among the most common points of discussion when evaluating the connection between an electronic patient care reporting (ePCR) system and billing.
Before the emergence of ePCR solutions, there were two primary means of communicating the patient care reporting data necessary to bill claims for the service agency. From the earliest days of billing for EMS calls, field personnel recorded incident data on a paper form that their organization submitted to the billing group in order to process the claims and pursue reimbursement for services. As the industry evolved, companies began to offer software that could be used to receive data input that was previously re-keyed from the paper report from the EMS agency. In both cases, paper forms drove the process, and the issue of data security became an emerging concern. Many agencies still use paper run reports today. With this method come security concerns that are certainly mitigated with an ePCR solution.
Paper forms are much more easily viewed and misplaced, allowing individuals to inappropriately access protected health information (PHI) for ill gain. Just like a credit card receipt from a restaurant can be unscrupulously used by a person seeking your credit card information or worse, paper run reports expose personal demographics and PHI. In contrast, the more advanced technologies facilitate an ePCR that is filled out at the scene on a laptop and encrypted immediately upon entry, virtually removing the possibility of identity theft or Health Insurance Portability and Accountability Act (HIPAA) violation from a run report.
All of this relates to data security, a major concern for any agency. With an electronic run report, your billing department (whether an internal group or a third-party agency) receives an encrypted electronic file that’s securely uploaded into their billing system, leaving little concern that the data may have been compromised in the process. Robust ePCR solutions that use data encryption have increased the security of data being recorded, from the field all the way through the billing process.
The most notable advantage of an ePCR system is the ability to collect all the data generated during a patient encounter—and then report on the data. When paper reports were the predominant means of capturing run information from the field, it was time-consuming and difficult to record clinical and system management information. Also, the ability for a medical director or department chief to make data-driven decisions regarding patient care, staffing configurations or training needs was complicated at best. Now that this information can be readily available via the database created by ePCRs, lives are being saved via meaningful observation and training, and departments are able to operate more efficiently through scheduling and positioning of their fleet. Again, these are only a few of the major benefits of the data gathered through an ePCR solution.
Much of the issue of reporting from a billing perspective revolves around detailed data passed from the ePCR to the billing system and the level of control of this documentation resulting from mandatory field completion requirements. Often, the billing extract from the ePCR system contains only patient demographics, insurance information and any run data needed to code the run for billing. Ideally, you should seek to map the entire ePCR data into the system, allowing coders to view the entire incident narrative and other recorded data. This assists them in making billing decisions related to level of service and medical necessity. The bottom line remains—enhanced incident reporting from the ePCR system is directly related to billing system performance.
Another advantage of an ePCR is greater reporting capabilities from your billing system. Traditionally, billing reports have included accounts receivable stats, gross and net billed amounts, mandatory adjustments and collections, to name the most common reports. However, given a robust extract from the ePCR, reporting from the billing group has become significantly more in-depth to include financial, clinical and basic management reports. Again, the value of the electronic record and the ability to see this information reported from a growing database has proven invaluable across the patient care continuum.
Naturally, cost is often one of the most common factors in considering an ePCR solution. The cost of an ePCR system includes such elements as hardware, mounting solutions, warranties, wireless equipment and monthly services, and potentially includes other equipment, such as servers and network administration fees. However, the benefits of added data security and reporting can mitigate expected costs and positively impact revenues.
The primary means of cost reduction is in data entry. With a solid integration between your ePCR solution and your billing system, all patient demographic information and incident information needed for the coding of the claims can be electronically populated, eliminating the need for personnel dedicated to the function of data input. Depending on the efficiency of your billing company or internal billing staff, this can knock out a fairly significant percentage of your billing system costs. As a result, many of the dedicated EMS billing services firms in the industry may offer a different rate to those agencies with whom an electronic interface between ePCR and billing system can be established to import patient care data.
A second element on the cost side is a reduction in the necessary account research by the billing department to ensure claims are properly recorded and coded. Certainly, legibility of the information is improved, reducing the time and expense associated with going back to field personnel for clarification.
Additionally, closed-call rules within the ePCR can be used to ensure that all data needed for billing is collected. Again, this reduces timely and costly follow-up attempts to retrieve this information. A prime example of this is the patient signature requirement for Medicare claims that was changed on Jan. 1, 2008. By fulfilling this requirement at the ePCR level, follow-up on the billing side is more narrowly confined, and thus a great deal of unnecessary cost is eliminated.
The result of the cost equation is that while added costs are surely taken on with the purchase of an ePCR solution, a portion of that can be offset by the reduced billing costs due to increased efficiency of a well-constructed interface. If the billing department or billing company is still required to print out the run report from the ePCR record and enter that information into the billing system, an opportunity is being missed that can bring further cost-savings to your agency.
In my experience, the issue of revenue enhancement from an ePCR solution is the most commonly misunderstood element of the entire value picture. Understandably, many companies offering an ePCR solution will point to the upside your agency will receive from billing due to the use of their system. After all, those of us selling these solutions understand we must show a measurable value to agencies considering the solution, and the most direct way of doing this is by discussing the issue of additional realized revenue.
Also, many of us have client-specific examples where the introduction of our ePCR solution made a significant positive contribution to revenue. For example, we began billing for a large agency and realized it was losing approximately 10% of its total transport volume before it ever made it to billing due to inefficiency in the collection of the paper run reports. Successfully dealing with this issue created a substantial revenue upside for the agency, which equaled a large portion of the ePCR system cost. But from my experience, this is the exception instead of the rule, and it’s completely dependent on the focus and knowledge of your billing process.
A strong ePCR solution offers many advantages that can positively impact revenue. For one, strong and complete clinical information allows for the proper coding of claims, which can increase the percentage of claims being billed and paid at a higher level of service. Two, this complete data can also allow for proper documentation to better establish medical necessity, which reduces denials or the need for timely and costly appeals. Finally, ensured legibility means the right information is included with the claims, which also creates a positive impact on revenues.
With all of that said, however, the blanket statement that "an ePCR solution will lead to better reimbursement results" must be tested within your own department. As a billing company in business for more than 30 years, we’ve always worked hard to ensure every component of the billing process is maximized, regardless of whether we were receiving the patient run reports electronically or on paper. This includes run report reconciliation to ensure we aren’t missing billable claims. It also includes gathering all the information needed to code a claim at the correct level and following the precise rules of compliance as well as making sure that all billable events, supplies, mileage and any other data elements are captured on the claim being submitted to the proper payer. To the extent that your billing agency or department is equally vigilant, the expectation of a big "bump" in revenue from adopting an ePCR solution may very well go unrealized.
The benefits of data security and reporting are obvious when you consider the level and clarity of data gathered at the time of the incident by the clinicians providing the care. From a cost perspective, strong reporting translates to data-driven decisions that can reduce costs, or simply result in added efficiency by eliminating such unnecessary tasks as data input or timely research on accounts that are illegible or incomplete. And don’t forget that benefits can be realized on the revenue side, but that it’s largely dependent on your billing practices alongside your ePCR solution.
Disclosure: The author has reported no conflicts of interest with the sponsors of this supplement.